HDL levels predict sepsis risk in hospitalized patients

Abstract

The authors suggest that low HDL cholesterol levels in the early stages of infection may protect against the development of sepsis and call for this hypothesis to be investigated in future studies.

Advertisement

A Brazilian team investigated the clinical relevance of the observed dramatic drop in lipoprotein levels during the acute-phase inflammatory response. In particular they sought to determine whether this fall in blood lipoproteins merely reflects the severity of acute inflammatory response, or whether low lipoprotein levels can be considered a risk factor for developing sepsis.

“This is an important distinction because in the first case HDL level is a prognostic marker, but in the latter, HDL level can be monitored and can predict sepsis,” explain Alexandre Carrilho (Londrina State University, Paraná) and fellow researchers writing in the European Journal of Clinical Investigation.

To investigate, they identified 1719 consecutive patients hospitalized for various indications and without severe sepsis on admission. In all, 51 patients developed the condition during hospitalization and were designated “cases.” They were compared with 71 age- and gender-matched patients (“controls”) who did not develop severe sepsis.

In multivariate logistic regression, HDL cholesterol was the only significant protective factor, with each 1 mg/dl (0.03 mmol/l) increase in HDL cholesterol associated with a 3% decrease in the risk for severe sepsis during hospitalization.

Among the patients who developed sepsis, HDL cholesterol levels on admission did not differ significantly between survivors and nonsurvivors.

However, the reduction in levels of cholesterol ester transfer protein (CETP) between admission and day 3 was significantly more pronounced in nonsurvivors than survivors (0.78 vs 0.02 µg/ml). This change in CETP was also significantly positively correlated with the severity of sepsis, as indicated by both APACHE II score and organ dysfunction.

“Ours is the first prospective study to report that low HDL cholesterol concentrations may be considered as a risk factor for the development of severe sepsis in hospitalized patients,” write Carrilho and colleagues.

“Further research is needed to elucidate whether these associations are causal or whether they represent uncontrolled data confounded by unmeasured risk factors.”